tbuckley/cabot-search huggingface dataset:
POS1061 RISK OF ACUTE MYOCARDIAL INFARCTION AND STROKE ASSOCIATED WITH ANTI-RHEUMATIC DRUGS IN PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONWIDE POPULATION-BASED STUDY
Authors: S. M. Ahn, Y. J. Lee, S. Hong, C. K. Lee, B. Yoo, J. S. Oh, Y. G. Kim
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The risk of acute cardiovascular events including acute myocardial infarction (AMI) and ischemic stroke in patients with rheumatoid arthritis (RA) is increased compared with the general population and is the leading cause of death in these patients. <h3>Objectives</h3> The present study aimed to investigate the risk of new-onset AMI/stroke following the initiation of different anti-rheumatic drugs for RA using a nationwide database. <h3>Methods</h3> This nested case–control study with a cohort of 35,133 AMI/stroke-naïve patients with RA was conducted using the Korean Health Insurance Review and Assessment (HIRA) database from 2011 to 2020. Cases with incident AMI/stroke were identified and individually matched to randomly selected controls (1:4). Anti-rheumatic drug use was measured for one year before the index date and stratified by exposure duration. The association of each anti-rheumatic drug with AMI/stroke risk was estimated using conditional logistic regression adjusted for comorbidities and concomitant drug use. <h3>Results</h3> Approximately 5.3% of patients (n=1,870) were newly diagnosed with AMI (n=484) or ischemic stroke (n=1,386). In total, 1,868 (excluding unmatched control [n=2]) AMI/stroke cases and 7,423 controls with newly diagnosed RA were included for analysis. In a multivariable-adjusted analysis, recent use (within three months) of leflunomide (adjusted odds ratio [aOR]=1.21, 95% confidence interval [CI]=1.06–1.37), glucocorticoids (aOR 1.84, 95% CI 1.61-2.11) and tocilizumab (aOR=2.04, 95% CI=1.11–3.75) were associated with increased AMI/stroke risk. The recent use of anti-TNF-alpha agents (aOR=0.72, 95% CI=0.52–0.99), sulfasalazine (aOR=0.79, 95% CI=0.66–0.93), and hydroxychloroquine (aOR=0.83, 95% CI=0.74–0.94) were associated with a significantly decreased AMI/stroke risk. <h3>Conclusion</h3> Anti-TNF-alpha agents, hydroxychloroquine, and sulfasalazine used to treat RA decreased the risk of AMI/stroke, whereas leflunomide, glucocorticoids, and tocilizumab increased this risk. <h3>References</h3> [1] Annals of the rheumatic diseases, 2017, 76.1: 17-28. [2] The Lancet Rheumatology, 2021, 3.1: e58-e70. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0730 TOCILIZUMAB TREATMENT IN SEVERE AND REFRACTORY BEHÇET’S SYNDROME: A CASE SERIES
Authors: Z. Toker Dincer, B. Yurttas, S. N. Esatoglu, D. Ucar, U. Uygunoglu, S. Ugurlu, Y. Ozguler, E. Seyahi, M. Melikoglu, I. Fresko, V. Hamuryudan, A. Siva, G. Hatemi
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Tocilizumab may be an alternative for patients with Behçet's Syndrome (BS) refractory to conventional immunosuppressives and TNF inhibitors. <h3>Objectives</h3> We aimed to report our experience with tocilizumab in patients with BS. <h3>Methods</h3> We identified BS patients who were treated with tocilizumab for eye, nervous system and arterial involvement, and amyloidosis, using our hospital's electronic medical records. Demographic and clinical features, previous therapy, treatment response, outcomes, and adverse events were retrieved from patient charts. <h3>Results</h3> A total of 12 patients with BS (M/F: 9/3, mean age 44.4±10.3 years) were treated with tocilizumab for uveitis (n=6), parenchymal nervous system involvement (n=2), aortitis (n=2) and amyloidosis (n=2) between 2014-2022. Previous treatment modalities and treatment response for uveitis are shown in Table 1. Only 2 of the 6 patients with uveitis obtained remission with tocilizumab. Both patients with neurological involvement were refractory to tocilizumab treatment. They had previously used colchicine, steroids, azathioprine, interferon-alpha, infliximab, and adalimumab. Additionally, one had used cyclophosphamide and the other methotrexate and mycophenolate mofetil. One of the patients with amyloidosis was unresponsive and underwent kidney transplantation. The other had improvement in proteinuria, but she developed Crohn disease and infliximab was started. One patient with aortitis had used steroids, colchicine, azathioprine, cyclophosphamide, infliximab and the other had used steroids, colchicine, azathioprine, interferon-alpha and methotrexate. Both patients with aortitis obtained remission. One of them discontinued tocilizumab voluntarily, and the other due to dyslipidemia. Overall, tocilizumab was discontinued in 10/12 patients after 10.1±7.8 months. Adverse events were increased mucocutaneous lesions in one and dyslipidemia in another patient. <h3>Conclusion</h3> BS patients with aortitis benefitted from tocilizumab. However, our experience with tocilizumab in patients with eye and nervous system involvement was not as favorable as reported in previous case series. This may be partly due to the long disease duration before tocilizumab and the patient's 'being difficult-to-treat patients, refractory to several previous biologics including TNF inhibitors and interferon-alpha. <h3>References</h3> [1]Akiyama M, Kaneko Y, Takeuchi T. Effectiveness of tocilizumab in Behcet's disease: A systematic literature review. Semin Arthritis Rheum. 2020 Aug;50(4):797-804. <h3>Acknowledgements</h3> none. <h3>Disclosure of Interests</h3> None Declared.
POS1575 ASSOCIATION OF IGG4-RELATED DISEASE AND SYSTEMIC RHEUMATIC DISORDERS
Authors: V. Batani, M. Lanzillotta, J. Mahajne, F. Pedica, D. Palumbo, E. Venturini, L. Dagna, E. Della Torre
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Autoimmune disorders can occur together especially in genetically predisposed individuals. Objectives: We here aimed to assess the occurrence of IgG4-related disease (IgG4-RD) in association with other systemic immune-mediated conditions. <h3>Methods</h3> We retrospectively analyzed the clinical records of our routinely followed patients with IgG4-RD for pre-existing or concomitant immune-mediated disorders. IgG4-RD was diagnosed based on histological findings and on the 2011 Comprehensive Diagnostic criteria. Associated immune-mediated disorders were diagnosed based on available classification and/or diagnostic criteria. <h3>Results</h3> Two-hundred and thirty-four patients with a definitive diagnosis of IgG4-RD were included in this study. A pre-existing immune-mediated connective tissue disease was reported in 6/234 patients (3%): one case each of sarcoidosis, Takayasu arteritis (TA), eosinophilic granulomatosis with polyangitis (EGPA), and rheumatoid arthritis; and two cases of granulomatosis with polyangitis (GPA). Organs involved by IgG4-RD included the lungs, the pancreas, the peritoneum, lacrimal glands, meninges and orbits. Sarcoidosis, EGPA, and TA preceded the onset of IgG4-RD. GPA preceded IgG4-RD onset in one case and occurred simultaneously in the other case. Rheumatoid arthritis occurred together with IgG4-RD in one case. <h3>Conclusion</h3> IgG4-RD can present in the context of pre-existing systemic immune-mediated disorders. Our observation suggests that "secondary" IgG4-RD may preferentially complicate chronic granulomatous conditions including large- and small-vessels vasculitis as well as sarcoidosis. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS1197-HPR HEALTH-RELATED MOBILE APPLICATIONS IN RHEUMATOID ARTHRITIS: WHAT ARE THE PATIENTS’ EXPECTATIONS?
Authors: E. Hannech, M. Yasmine, S. Miladi, A. Fazaa, H. Boussaa, K. Ouenniche, L. Souabni, S. Kassab, S. Chekili, K. Ben Abdelghani, A. Laatar
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The use of mobile phone applications for the management of rheumatic diseases (RD) has grown significantly these past few years [1]. Nevertheless, the success of these applications requires identifying the educational needs and interests of patients with RD. <h3>Objectives</h3> The purpose of our study was to investigate the expectations of rheumatoid arthritis (RA) patients regarding mobile applications in managing their disease. <h3>Methods</h3> We conducted a cross-sectional survey in our rheumatology department including RA patients, fulfilling the ACR/EULAR 2010 criteria. They were invited to respond to a questionnaire related to the utility of a mobile application in managing their disease. We evaluated their point of view on the desired functions of a smartphone app, the required content as well as the preferred design. <h3>Results</h3> The study included 40 RA patients: 36 females (90%) and 4 males (10%). The mean age was 52.25±14.4 years [21-78]. The mean disease duration was 11.97±6.69 years [1-29]. Two items were considered important and concerned the ability to contact the doctor when necessary and discuss their symptoms (72%), as well as the ability to check laboratory results (72%). Other features listed as useful were reminder date of clinic appointments (65%), and reminder of hours' medication intake (60%). Nearly half of the patients expected the app to include educational videos (52%), exercise strategies to feel better (52%), ways to improve lifestyle habits (sports, sleep, professional activity, and dietary habits) (52%) and information about alternative treatments (55%). When asked about "what kind of health-related information should be tracked or monitored using a smartphone application?", the most requested data to monitor concerned disease symptoms tracking (45%) using a validated measures of disease activity (43%), pain and fatigue (52%) using pain and general well-being questionnaires (41%) as well as arthritis-related functional scores (42%). Regarding the design, the application should be simple (68%), quick (63%), with clear font (44%). Moreover, it shouldn't require too much battery power (42%), and include frequent recall notices (42%). <h3>Conclusion</h3> Our study showed that RA patients prioritized information about medications and monitoring their disease. Surprisingly, the availability of lab results was considered an important component of the app. Identifying these needs will be the first step to ensure the success of the mobile phone applications. <h3>Reference</h3> [1] Mollard E, Michaud K. Self-Management of Rheumatoid Arthritis: Mobile Applications. Curr Rheumatol Rep. 2020; 26;23(1):2. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0849 JAK INHIBITORS IMPROVE SEROPOSITIVE REFRACTORY MYOSITIS: SINGLE CENTER EXPERIENCE
Authors: M. Kosmetatou, G. S. Moysidou, S. Flouda, N. Michalakeas, M. Gerohristou, A. Filippopoulou, K. Zoupidou, P. Katsimpri, D. Boumpas, C. Mavragani
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Inflammatory myopathies are heterogeneous with variable clinical course and prognosis [1]. Despite conventional treatment, some patients are refractory [2]. <h3>Objectives</h3> To describe the efficacy and safety of JAK inhibitors (JAKi) in patients with refractory dermatomyositis (DM). <h3>Methods</h3> Retrospective analysis of 6 patients with active DM, refractory to previous immunosuppressive treatment including methotrexate, rituximab, mycophenolate mofetil, cyclophosphamide and intravenous immunoglobulin. Demographical, clinical characteristics, outcomes and adverse events after JAKi administration were recorded. <h3>Results</h3> 83.3% of the patients were women, with mean age 62.4±10.9 years. All patients had long-standing disease with mean disease duration 9±8.1 years. Three patients were seropositive: one with positive anti-MDA5 antibodies, one with association of anti-Jo1 and anti-Ro52 antibodies and the latter with positive anti-Ro52 antibodies. The most frequently used JAKi was upadacitinib (50%), followed by tofacitinib (33.3%) and baricitinib (16,6%). Mean daily dose of corticosteroids at baseline was 8. 5mg.Prior to treatment with JAKi, mean muscle strength was 108±35, with mean CPK levels of 997±2244. Four patients had active skin rash. After a mean follow-up period of 7.6 months, all four patients with persistent skin involvement had clinical response (MMT-8=127±30). Muscle strength was improved in 4 patients (66.6%). Of note, the two patients that did not respond to JAKi were seronegative with marked muscular atrophy. One patient discontinued treatment due to severe thrombocytopenia. No other adverse events were recorded. <h3>Conclusion</h3> In this case series, JAKi treatment resulted in clinical improvement in seropositive patients with longstanding, refractory DM with acceptable safety profile. Prospective data are necessary to confirm these preliminary findings and define the subset of DM patients most likely to benefit from JAKi treatment. <h3>References</h3> [1]Lundberg, I.E., Fujimoto, M., Vencovsky, J. <i>et al.</i> Idiopathic inflammatory myopathies. <i>Nat Rev Dis Primers</i><b>7</b>, 86 (2021). [2]Oddis CV, Aggarwal R. Treatment in myositis. Nat Rev Rheumatol. 2018 May;14(5):279-289. doi: 10.1038/nrrheum.2018.42. Epub 2018 Mar 29. Erratum in: Nat Rev Rheumatol. 2018 Oct;14(10):619. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS1205-HPR PRESCRIBING TRENDS OF METHOTREXATE IN RHEUMATOID ARTHRITIS: A TUNISIAN SURVEY
Authors: F. Alia, O. Hamdi, S. Miladi, M. Yasmine, H. Boussaa, L. Souebni, K. Ouenniche, S. Chekili, S. Kassab, K. Ben Abdelghani, A. Laatar
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Methotrexate (MTX) remains the first line disease modifying antirheumatic drug (DMARD) in the course of treatment for rheumatoid arthritis (RA). There are wide variations in prescribing pattern among rheumatologists. <h3>Objectives</h3> We aimed to determine the prescribing practices of MTX by Tunisian rheumatologists. <h3>Methods</h3> We conducted a cross-sectional study including Tunisian rheumatologists. An online survey composed of 18 questions via Google Drive Forms was designed to analyse the prescription trends of MTX in RA patients. <h3>Results</h3> The online questionnaire was sent to 184 rheumatologists, 66 of whom (35.8%) responded. The majority of rheumatologists initiated MTX at therapeutic doses: 10 mg/week (34.8%) and 15 mg/week (36.3%). Ninety-eight percent of rheumatologists preferred the oral route during the initiation of MTX. Fifty-nine percent of rheumatologists advised their patients to take MTX on an empty stomach. Doctors preferred injectable MTX in case of digestive intolerance (96.9%) or in case of lack of efficacy (48.4%). Regarding the MTX escalation strategy, the majority of rheumatologists followed a conventional strategy with an increase in doses in steps of 2.5 mg (65%) and 5 mg (35%) every 02 (16.6%) to 04 (42.4%) weeks. The optimal dosage of MTX was reached after 08 and 12 weeks in 27.2% and 59% of cases, respectively. Sixty-eight percent of rheumatologists split doses of MTX, 60% of whom from a dose of 15 mg/week. The time interval between the two doses was 06 (27.2%) to 12 hours (27.2%). All rheumatologists systematically associated folic acid with MTX. The average dose of folic acid prescribed was 10 mg/week (72.7%). The doctors questioned advised patients to take acid folic 48 hours after MTX 51.5%. The maximum dose of MTX prescribed by rheumatologists before switching to biological (b) DMARDs was 20 mg/week (60.6%). In case of use of bDMARDs, 63.6% of doctors decreased the dose of MTX to 10 mg/week. Once remission is reached, 34.8% of doctors continued MTX at the same dose while 62% of them gradually reduced the dose (decrease of 2.5mg every 02 weeks in 27.2% of cases and 5 mg every 08 weeks in 34.8% of cases). <h3>Conclusion</h3> Our study showed that the majority of Tunisian rheumatologists prescribe MTX according to international recommendations. Indeed, the current therapeutic strategy for RA encourages powerful and effective treatment early in the course of the disease. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0603 WORKING TOWARDS A CORE MINIMAL DATASET FOR SYSTEMIC LUPUS ERYTHEMATOSUS STUDIES
Authors: S. Mcdonald, J. Teng, M. Barraclough, I. N. Bruce
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease and its heterogeneity means that many cohorts and clinical trials do not collect the same data, making comparative studies difficult. <h3>Objectives</h3> We aimed to ascertain what data is commonly collected in SLE registries/trials. Our ultimate goal is to generate a core minimal dataset for future SLE studies.#8232; <h3>Methods</h3> We designed and distributed a questionnaire to members of the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) as well as additional research active centres in China. Our survey included 26 questions about the types of data that are routinely collected for research. Data collected by ≥ 75% of participating centres was used as a threshold for concordance.#8232; <h3>Results</h3> Eighteen centres; eight from USA/Canada, five from China and five from Europe responded. Table 1 shows the data that ≥ 75% centres collected. Notably, the EULAR/ACR 2019 criteria was collected by 33.3% and even the most commonly collected patient reported outcome (PRO) - the SF36, was only collected by 53.3%. The SLICC/ACR SLE damage index did not reach our threshold (68.4%). Current treatment data collected did include drug name, dose, frequency and start date. Previous treatment reason for cessation was collected only pertaining to antimalarials. Baseline anti-dsDNA (ELISA) and Crithidia were collected by 70.6% and 52.9% respectively and baseline immunoglobulins were measured by 70.6%. Follow-up blood counts and complement C3/4 were collected by ≥ 75% of centres. <h3>Conclusion</h3> An initial set of commonly collected data was identified. This forms the basis to start to consider a core minimum dataset for SLE. Development and further refinement of this dataset is needed, as will common definitions of each data field to allow widespread use. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Stephen McDonald: None declared, Jialin Teng: None declared, Michelle Barraclough: None declared, Ian N. Bruce Speakers bureau: Speaker for AstraZeneca, GSK and UCB. , Consultant of: Consultancies; Eli Lilly, GSK, Merck Serono, UCB and ILTOO., Grant/research support from: Grants/research support; Genzyme/Sanofi, GSK, Roche and UCB.
AB1362 STUDY OF ADVERSE REACTIONS TO COVID-19 VACCINATION IN PATIENTS WITH RHEUMATIC DISEASES
Authors: Y. Akiyama, M. Matsuda
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Vaccination has been recommended in the midst of the COVID-19 pandemic, but some patients are not vaccinated due to concerns about adverse reactions. <h3>Objectives</h3> The purpose of this study is to investigate the adverse reactions in rheumatic diseases and to guide the decision-making of patients and physicians. <h3>Methods</h3> A questionnaire was sent to patients with rheumatic diseases, and patients who could be counted as of September 2021, when they consented to this study, were surveyed. <h3>Results</h3> The subjects were 123 (male:female=10:113), 84 with rheumatoid arthritis and 39 with other immune diseases. The therapeutic agents used were PSL 31(25.2%), MTX 65(52.8%), NSAID/COX inhibitors 28(22.8%), bDMARDs 42(34.1%). adverse reactions after the first and second vaccination were fever 17(13.8%)/50(40.7%), joint symptoms 7(5.7%)/22(17.9%), local injection reactions (pain/irritation) 22(17.9%), local injection reactions (pain/erythema) 93(75.6)/98(79.7), systemic skin symptoms 0(0%)/2(1.6%), other symptoms (malaise, myalgia, etc.) 59(48.0%)/85(69.1%), and treatment intensification 5(4.1%)/12(9.7%). These responses differed in occurrence only for fever with and without PSL medication (22.5%: 47.3% (p=0.02)).The odds ratio for disease worsening after the first dose of vaccine and again after the second dose was 33.5 (p&lt;0.01). <h3>Conclusion</h3> No specific adverse reactions other than the commonly known ones were observed, but some patients experienced worsening of symptoms after vaccination, requiring intensified treatment. Based on the results of this study, we believe that adverse reactions to vaccination are acceptable. We plan to accumulate more cases and analyze them in the future.The exacerbation of disease after the first vaccination would predict the exacerbation after the second vaccination. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB1047 COMORBIDITY WITH FIBROMYALGIA IS ASSOCIATED WITH INCREASED JOINT SWELLING, HIGH DISEASE ACTIVITY AND REDUCED PRODUCTIVITY IN THAI PATIENTS WITH SPONDYLOARTHRITIS
Authors: P. Chiowchanwisawakit, S. Srivorrapattarakul
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Spondyloarthritis (SpA) is a chronic inflammatory disease and may present with diffuse pain. Fibromyalgia (FM) is a non-inflammatory diffuse pain syndrome and may be a co-morbid disease of SpA. No prior study of prevalence FM and its effect on Thai patients with SpA. <h3>Objectives</h3> To estimate the prevalence and explore the associated factor of fibromyalgia among patients with spondyloarthritis in Thailand. <h3>Methods</h3> This was a cross-sectional study. Thai patients with SpA were consecutively recruited. FM was diagnosed according to the 2016 revision of the 2010/ 2011 American College of Rheumatology diagnostic criteria. The characteristics of the patients, physical examination, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Work Productivity and Impairment Questionnaire and EuroQoL-5 dimensions (EQ5D) were collected. The Fischer exact test or the Mann-Whitney U test was used to compare the associated factors. <h3>Results</h3> Of the total of 218 patients with 113(51.8%) female, mean age of 49.5 years, and median disease duration of 6 years, 12 (5.5%) were diagnosed with FM. Pain areas and symptoms between the patients with and without FM was shown at Figure 1. FM patients were associated with a higher median tender joint count [1.0 vs 0, <i>p</i>=0.020] and swollen joint count [1.5 vs 0, <i>p</i>=0.037], BASDAI&gt;4/10 [7(58.3%) vs 34(16.5%), <i>p</i>=0.002], mean EQ5D index [0.6 vs 0.88, <i>p</i>=0.001], median overall work impairment [65 vs 10%, <i>p</i>=0.002], and activity impairment [50 vs 10%, <i>p</i>=0.001] than those without FM. <h3>Conclusion</h3> The prevalence of FM among Thai patients with SpA is low. However, it is important to identify and treat because it is associated with reduced productivity and poor quality of life. Active inflammation is associated with FM. Controlling SpA disease may also help to control FM. <h3>Acknowledgements</h3> This study was supported by a grant from the Siriraj Research Fund, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (grant no. R016331042). The authors gratefully acknowledge the patients that participated in this study; the EuroQol group for permission to use the Thai version of the EQ-5D-5L. <h3>Disclosure of Interests</h3> None Declared.